When does Medicare pay first? When does Employer pay first?

The answer depends on the number of employees the employer has. When a company has 20+ employees, the employer is primary, and Medicare is secondary. When the company has fewer than 20 employees, Medicare is primary, and the employer is secondary.

Scenario

Primary Payer

Secondary Payer

Employer with 20+ employees

Employer

Medicare

Employer with fewer than 20 employees

Medicare

Employer

On spouse's insurance and employer has 20+ employees

Employer

Medicare

On spouse's insurance and employer has fewer than 20 employees

Medicare

Employer

Retiree from non-federal job with health insurance from former employer

Medicare

Employer

Retired and spouse's employer's plan for business with fewer than 20 employees

Medicare

Employer

Retired and spouse's employer's plan for business with 20+ employees

Employer

Medicare

Retired federal employee

Medicare

Federal Employees and Health Benefits Program

TRICARE*

See below

COBRA

Medicare

COBRA

Medicaid

Medicare

Medicaid

Under 65, disabled and have coverage through a family member's employment and employer has 100+ employees

Employer

Medicare

 

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